Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time. As long as it happens infrequently, it's not cause for concern.

However, you may meet the diagnostic criteria for premature ejaculation if you:

Always or nearly always ejaculate within one minute of penetration

Are unable to delay ejaculation during intercourse all or nearly all of the time

Feel distressed and frustrated, and tend to avoid sexual intimacy as a result

Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed to talk about it, premature ejaculation is a common and treatable condition. Medications, counseling and sexual techniques that delay ejaculation — or a combination of these — can help improve sex for you and your partner.

The primary symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration. However, the problem may occur in all sexual situations, even during masturbation.

Premature ejaculation can be classified as lifelong (primary) or acquired (secondary). Lifelong premature ejaculation occurs all or nearly all of the time beginning with your first sexual encounters. Acquired premature ejaculation has the same symptoms but develops after you've had previous sexual experiences without ejaculatory problems.

Many men feel that they have symptoms of premature ejaculation, but the symptoms do not meet the diagnostic criteria for premature ejaculation. Instead these may have natural variable premature ejaculation, which is characterized by periods of rapid ejaculation as well as periods of normal ejaculation.

When to see a doctor

Talk with your doctor if you ejaculate sooner than you wish during most sexual encounters. It's common for men to feel embarrassed about discussing sexual health concerns, but don't let that keep you from talking to your doctor. Premature ejaculation is a common and treatable problem.

For some men, a conversation with their doctor may help alleviate concerns about premature ejaculation. For example, it may be reassuring to hear that occasional premature ejaculation is normal and that the average time from the beginning of intercourse to ejaculation is about five minutes.

The exact cause of premature ejaculation isn't known. While it was once thought to be only psychological, doctors now know premature ejaculation is more complicated and involves a complex interaction of psychological and biological factors.

Psychological causes

Some doctors believe that early sexual experiences may establish a pattern that can be difficult to change later in life, such as:

Situations in which you may have hurried to reach climax in order to avoid being discovered

Other factors that can play a role in causing premature ejaculation include:

Erectile dysfunction. Men who are anxious about obtaining or maintaining an erection during sexual intercourse may form a pattern of rushing to ejaculate, which can be difficult to change.

Anxiety. Many men with premature ejaculation also have problems with anxiety — either specifically about sexual performance or related to other issues.

Relationship problems. If you have had satisfying sexual relationships with other partners in which premature ejaculation happened infrequently or not at all, it's possible that interpersonal issues between you and your current partner are contributing to the problem.

Biological causes

A number of biological factors may contribute to premature ejaculation, including:

Abnormal hormone levels

Abnormal levels of brain chemicals called neurotransmitters

Abnormal reflex activity of the ejaculatory system

Certain thyroid problems

Inflammation and infection of the prostate or urethra

Inherited traits

Nerve damage from surgery or trauma (rare)

Various factors can increase your risk of premature ejaculation, including:

Erectile dysfunction. You may be at increased risk of premature ejaculation if you occasionally or consistently have trouble getting or maintaining an erection. Fear of losing your erection may cause you to consciously or unconsciously hurry through sexual encounters.

Health problems. If you have a serious or chronic medical condition, such as heart disease, you may feel anxious during sex and may unknowingly rush to ejaculate.

Stress. Emotional or mental strain in any area of your life can play a role in premature ejaculation, often limiting your ability to relax and focus during sexual encounters.

Stress and relationship problems. A common complication of premature ejaculation is relationship stress.

Fertility problems. Premature ejaculation can occasionally make fertilization difficult or impossible for couples who are trying to have a baby.

It's normal to feel embarrassed when talking about sexual problems, but you can trust that your doctor has had similar conversations with many other men. Premature ejaculation is a very common — and treatable — condition.

Being ready to talk about premature ejaculation will help you get the treatment you need to get your sex life back on track. The information below should help you prepare to make the most of your appointment.

Information to write down in advance

Pre-appointment restrictions. At the time you make your appointment, ask if there are any restrictions you need to follow in the time leading up to your visit.

Symptoms. How often do you ejaculate before you or your partner would wish? How long after you begin having intercourse do you typically ejaculate?

Sexual history. Think back on your relationships and sexual encounters since you became sexually active. Have you had problems with premature ejaculation before? With whom, and under what circumstances?

Medical history. Write down any other medical conditions with which you've been diagnosed, including mental health conditions. Also note the names and strengths of all medications you're currently taking or have recently taken, including prescription and over-the-counter drugs.

Questions to ask your doctor. Write down questions in advance so that you make the most of your time with your doctor.

Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

What to expect from your doctor

Your doctor may ask a number of very personal questions and may also want to talk to your partner. To help your doctor determine the cause of your problem and the best course of treatment, be ready to answer questions such as:

How often do you have premature ejaculation?

Has this problem developed gradually or suddenly?

Do you have premature ejaculation only with a specific partner or partners?

Do you experience premature ejaculation when you masturbate?

Do you have premature ejaculation every time you have sex?

How often do you have sex?

How much are you bothered by premature ejaculation?

How much is your partner bothered by premature ejaculation?

How satisfied are you with your current relationship?

Are you also having trouble getting and maintaining an erection (erectile dysfunction)?

Do you take prescription medications? If so, what medications have you recently started or stopped taking?

Do you use recreational drugs?

What you can do in the meantime

Deciding to talk with your doctor is the most important step you can take. In the meantime, consider exploring other ways in which you and your partner can connect with one another. Although premature ejaculation can cause considerable strain and anxiety in a relationship, it is a treatable condition.

In addition to asking about your sex life, your doctor will ask about your health history and may perform a general physical exam. Your doctor may order a urine test to rule out possible infection. If you have both premature ejaculation and trouble getting or maintaining an erection, your doctor may order blood tests to check your male hormone (testosterone) levels or other tests.

In some cases, your doctor may suggest that you go to a urologist or a mental health professional who specializes in sexual dysfunction.

Common treatment options for premature ejaculation include behavioral techniques, topical anesthetics, oral medications and counseling. Keep in mind that it may take a little time to find the treatment or combination of treatments that will work for you.

Behavioral techniques

In some cases, therapy for premature ejaculation may involve taking simple steps, such as masturbating an hour or two before intercourse so that you're able to delay ejaculation during sex. Your doctor also may recommend avoiding intercourse for a period of time and focusing on other types of sexual play so that pressure is removed from your sexual encounters.

The pause-squeeze technique

Your doctor may instruct you and your partner in the use of a method called the pause-squeeze technique. This method works as follows:

Begin sexual activity as usual, including stimulation of the penis, until you feel almost ready to ejaculate.

Have your partner squeeze the end of your penis, at the point where the head (glans) joins the shaft, and maintain the squeeze for several seconds, until the urge to ejaculate passes.

After the squeeze is released, wait for about 30 seconds, then go back to foreplay. You may notice that squeezing the penis causes it to become less erect, but when sexual stimulation is resumed, it soon regains full erection.

If you again feel you're about to ejaculate, have your partner repeat the squeeze process.

By repeating this as many times as necessary, you can reach the point of entering your partner without ejaculating. After a few practice sessions, the feeling of knowing how to delay ejaculation may become a habit that no longer requires the pause-squeeze technique.

Topical anesthetics

Anesthetic creams and sprays that contain a numbing agent, such as lidocaine or prilocaine, are sometimes used to treat premature ejaculation. These products are applied to the penis a short time before sex to reduce sensation and thus help delay ejaculation. A lidocaine spray for premature ejaculation (Promescent) is available over-the-counter.

Although topical anesthetic agents are effective and well-tolerated, they have potential side effects. For example, some men report temporary loss of sensitivity and decreased sexual pleasure. In some cases, female partners also have reported these effects. In rare cases, lidocaine or prilocaine can cause an allergic reaction.

Oral medications

Many medications may delay orgasm. Although none of these drugs is specifically approved by the Food and Drug Administration to treat premature ejaculation, some are used for this purpose, including antidepressants, analgesics and phosphodiesterase-5 inhibitors. These medications may be prescribed for either on-demand or daily use, and may be prescribed alone or in combination with other treatments.

Antidepressants. A side effect of certain antideph3essants is delayed orgasm. For this reason, selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac, Sarafem), are used to help delay ejaculation. If SSRIs don't improve the timing of your ejaculation, your doctor may prescribe the tricyclic antidepressant clomipramine (Anafranil). Unwanted side effects of antidepressants may include nausea, dry mouth, drowsiness and decreased libido.

Analgesics. Tramadol (Ultram) is a medication commonly used to treat pain. It also has side effects that delay ejaculation. It may be prescribed when SSRIs haven't been effective. Unwanted side effects may include nausea, headache and dizziness.

Phosphodiesterase-5 inhibitors. Some medications used to treat erectile dysfunction, such as sildenafil (Viagra, Revatio), tadalafil (Cialis, Adcirca) or vardenafil (Levitra, Staxyn), also may help premature ejaculation. Unwanted side effects may include headache, facial flushing, temporary visual changes and nasal congestion.

Counseling

This approach, also known as talk therapy, involves talking with a mental health provider about your relationships and experiences. These sessions can help you reduce performance anxiety and find better ways of coping with stress. Counseling is most likely to help when it's used in combination with drug therapy.

Several alternative medicine treatments have been studied, including selected behavioral therapies (yoga) and surgical treatments. However, more research is needed to evaluate how effective and safe these therapies may be.

Asimakopoulos AD, et al. Does current scientific and clinical evidence support the use of phosphodiesterase type 5 inhibitors for the treatment of premature ejaculation? A systematic review and meta-analysis. Journal of Sexual Medicine. 2012;9:2404.

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